New Proposal of Finasteride (Propecia) Mechanism of Action

[Trinder3467]

Hi, you might as well congratulate me I just started Proscar 5g cut into 4 pieces. My second week, so far no side effects. I couldn't seem to find Propecia on your website though. I was wondering if the prices differ.

[samlammd]

@Trinder3467 propecia is more expensive, quite a bit more. however it is going off patent in 2013. i do not sell propecia. i just educate about it. i have no financial affiliation of any kind with the company.

[Trinder3467]

@samlammd Off patent? What is the cause? But what am I really in for if I keep up with Proscar? I don't yet have any children neither am I married. If speaking on a level of man-to-man NOT doctor-to-patient.

[samlammd]

@Trinder3467 it should not affect your ability to have children. off patent means that their patent rights are about to expire.

[Trinder3467]

@samlammd I've sent you an information earlier about the youtube user: concerned11. He's very popular on any Propecia video and claims to have had irreversible impotence due to the use of the drug. How serious can this be?

[samlammd]

@Trinder3467 i have probably written a thousand prescriptions and i do have one patient who claims the same. i truly do not know but i believe in the vast majority of individuals it is an extremely safe drug.

[Trinder3467]

@samlammd I have actually written to him and he replied, explaining that he developed impotence and that the safest and natural way to reduce DHT is to apply a Cinnamon toothpaste externally into the perineum area of the prostate which will cause the shrincage. I for one found it much unsafe because if your prostate is shrunk, wouldn't that count as an unhealthy start for someone fighting erectyle dysfunction? To sum up that's exactly what worries me about Proscar - is DHT inhibition.

[samlammd]

@Trinder3467 sounds a bit unusual to me.  have no idea about the toothpaste. i can only speak of proven, FDA medications.

[Trinder3467]

@samlammd I couldn't help but notice that this guy also mentions your account name in his messages on almost every comment he leaves on propecia videos. This is one of them: /watch?v=Nh6tPOt_akQ It's the very top comment with 3 thumbs up.

[Trinder3467]

@samlammd Hi. I realised that you wouldn't want to discuss the crazy fellow that mentions Propecia as an Imporence drug. But I thought you should know that since he indicates your account on his messages. I would've sent you this on private comment section but I am not much of a youtube user so I don't know how to do so.

[samlammd]

@Trinder3467 i am confused. what do you mean he indicates my account in his messages?

[Trinder3467]

@samlammd /watch?v=JNKT9Xgt3tc It's the top comment, four thumbs up, the user name is: concerned11. Every Propecia based video is tainted by his comment. Well, actually only those who allow anti-propecia messages.

[samlammd]

@Trinder3467 the video is unavailable that you gave me.

[Trinder3467]

@samlammd Here's what you can do then. Go to google. Type in: "concerned11 samlam md". You will find youtube videos with this guy's comments in which he mentions not only your account but numerous other transplant doctors'.

[samlammd]

@Trinder3467 i went there. didn't see anything but that is fine. there is enough stuff on the Internet that I cannot control. thanks though.

[Trinder3467]

@samlammd you're welcome. It's true, none to worry. I believe that's how Finasteride got tainted - the internet influence. Who knows, maybe he did actually become impotent but I asked whether or not he ever tried to sue the company, he never replied. I guess I'll never know what his cause is.

[samlammd]

@Trinder3467 cool. :)

[tallifornia90210]

I feel the use of finasteride is a bad idea. I was wondering if any pharmaceutical companies have looked into the posibility of a topical with 3 alpha hydroxysteroid reductase (3a-HSD) to counteract the dht in situ? It breaks down DHT by into the weak metabolite 5alpha-androstan-3a, 17b-diol which itself is a precursor to testosterone. This is what happens in skeletal muscle and why T is the anabolic agent and not DHT. Such a topical with Wnt 7a protein and IGF1 could be far more effective.



[bendobox]

My new physician keep saying that I don't need propeica, but my preivious physcian suggested me to take the drug and my hair becomes thicker after I have been taking the drugs. The hair thickness is fine because of I have been taking propeica!

[bendobox]

Hi Dr. I have been using propeica for 3 years. Everyhing seems fine. My hair became thicker comparing to 3 years ago before I used it. But I have recently changed to a new physician, the propecia I have from his prescription seems strange. After I took it for two moths, my hair thickness has gone back to 3 yrs ago before I took the drug. Would it be possible that he is giving me a psuedo drugs?

[samlammd]

@bendobox well, he technically should not be giving you a medication. he should be giving you a prescription to get the medication at a reputable pharmacy. at least that is how it is done in the United States. i cannot speak for how it is done elsewhere.

[sanchopanza123]

Dr. I love the way you back up your arguments with studies, unlike others. I am kinda confused about propecia and rogaine. I have realized that the two seem to work (havent used any) but I am concerned about the said side effects, there is a community anti-propecia that say it causes irreparable sexual disfunction, but I am also concerned if I take rogaine because it could have side effects for the heart. I face the dilemma of I guess choosing my risk. thks

[samlammd]

@sanchopanza123 i believe that it is safe but obviously, there are no guarantees. hopefully, you will find the right answer for you.

[DATART85]

i've been using finasteride for about 3 years now . it has worked good on me so far...my question is if after 3 or 4 years would it still work the same? (sorry for my english, it's not my first language)

[samlammd]

@DATART85 yes, data out 5 years shows that although you continue to lose hair you will have lost much less than someone else that was not on it over those 5 years. the only thing is that in the first year you gain some of the thickness back. after that it is a question of losing less so people "see less effect" when in fact what they don't see is that they would have lost a lot more without it. hope that is clear.

[Trinder3467]

@samlammd HI. I have a question about Proscar and its relation to prostate health. I consulted with my urologist, endocrinologist and androglist. They all forbid me to take any Finansteride drug because I, as they say, is in perfect health (hormone wise). But my Trichologist insists that Proscar is the only way to go for me. I cannot decide because my prostate is fine, why ruin it for hair? Is there a non-anti-androgen way to reverse AGA? How much reduction of DHT is needed in numbers?

[samlammd]

@Trinder3467 1. i don't think your prostate will be negatively impacted but you should youtube "prostate, psa, and finasteride" or some title like that. i have video on it. i do not believe there is a significant non-anti-androgen way to reverse AGA except minoxidil that works very well especially when combined with finasteride. i cannot speak on how much DHT reduction you need though.  no one really knows that.

[Trinder3467]

@samlammd What about softer erections and erectyle dysfunction? It's written down in the prescription list. Why can't I have both thick hair and good erections? If I do start taking proscar 1mg. and develop libido problems, will you or any other hair doctor take responsibility for that? If not, then it's a huge risk to take.

[samlammd]

@Trinder3467 1.  the odds of ED are 2% with 57% of people who continue with it after a month not having any further problems who originally did have a problem. these are the published reports. 2. no, you have to take responsibility for your actions. you take your own risks so long as you know the published data. :)

[Trinder3467]

@samlammd If Propecia once discontinued, they hair will fall away. Taking the drug for the rest of your life means developing stomach problems as well since it's a hard pill. what then?

[samlammd]

@Trinder3467 good point. that is the downside of taking it. if you stop you lose everything you gain. but the longer you wait to start the less useful is the product. it must be started as early as possible to have a better chance of slowing down and preventing loss. stomach problems? what are you talking about?

[Trinder3467]

@samlammd Stomach problems are inevitable because of the hardness of the pill. At some point it will mess with the digestion tract. My situation is like this: I'm 25 years old, I developed a mild thinning in April 2011. The recession is at the crown area, but it seems that's not receding any further. My Hair Doctor agress as well. If I use Rogain on that spot, regrow hair and then dump it. Will I lose the hair back till its original state or more than before the use of it?

[samlammd]

@Trinder3467 1. indigestion is not inevitable. it has been probably 15 years for many of my patients with no indigestion. 2. rogaine plus propecia is a lot better than rogaine alone. no, use of rogaine will not make it worse over time. you will just lose what you got from it during the years you were on it.

[Trinder3467]

@samlammd Okay, if we agree that Propecia and Rogaine are the cure all and the end all of the hair loss problem, why do we still to this day see men lose hair and not be able to do anything. Anybody can afford propecia/rogaine.

[samlammd]

@Trinder3467 propecia and rogaine are not cures. they will not stop hair loss, just slow it down. it is like a speeding train that has better brakes on it.

[Trinder3467]

@samlammd I also don't understand the process of hair transplant vs. thinning hair. If a patient is slowly thinning and does a hair transplant should he not fear the fact that later in his life he will totally lose the hair in the back of his head and end up with nothing to cover the loss with. That is of course we are talking about a patient that refuses to take Propecia.

[samlammd]

@Trinder3467 sort of. the hair from the back of the head is genetically programmed never to be lost. think of terry bradshaw or a similarly very bald man. he still has hair as a horseshoe unless he shaves it off. unfortunately, when you are very young there are two problems. we do not know how much hair back there really is safe. second, i don't know if future transplants will cover the degree of loss that would naturally occur around the permanently transplanted hairs.

[Trinder3467]

@samlammd My Trichologist tells me that the DHT is the primary cause of hair thinning. But in reality, they know never know unless they take a look at the situationo of your full hair. For example, I went to a hair doctor once in 2007. I was surprised to hear that I have a full head of hair and that I don't have androgenic alopecia. I had thicker, fuller hair with no crow recession. That sort of put my actions to sleep about hair loss. But now since it's visible I am diagnosed with...

[Trinder3467]

@samlammd .... AGA. The question is: If the MPB can only be diagnosed visually. Why are doctors so sure that DHT levels in blood are the main cause of it? Is it because in 2007 I had lower levels of it and now it;s higher it's hitting the follicles? Because with Diabetes the blood test shows Insulin levels and sugar in blood. In hair, it's based upon appearance.

[samlammd]

@Trinder3467 that is correct.

[Trinder3467]

@samlammd Despite DHT level, what are other factors of thinning hair?

[samlammd]

@Trinder3467 for men, that is the big one.

[Trinder3467]

@samlammd yet it's not the only one as it turns out. I was prescribed Vitamins to go with Proscar in particular: Zinc, Vitamin E, follic acid, b-group vitamins. Also a Chronostim spray for night and day, shampoo with Sabal ingredient. What are your views on "Mezotherapy" procedures? Do they have a Rogaine effect as well?

[samlammd]

@Trinder3467 personally, i believe beyond rogaine and propecia, there are no certain other ingredients for improving your hair.

[Trinder3467]

@samlammd I know I have asked this before and I will be dumb enough to ask again but have you checked on the Tom Cruise's hair situation. The man is 50 years old, claims it's his own, teenage hairline, zero recession and the tickness is not even explainabe. Do you examine the possibility that he too uses Finasteride? If not, then I don't even know what they call that.

[samlammd]

@Trinder3467 ok, i appreciate the questions but i really cannot keep this up. i am trying to be generous with my time but please no more questions for now. in answer to your question tom cruise could just be born without male pattern baldness. there are a ton of men who do not lose hair believe it or not. :)

[Trinder3467]

@samlammd I've accidentaly stumbled across a youtube user who seems to be very popular on anti-propecia campaign. Here's the video: /watch?v=TofYiX8hCso. His nick is: concerned11, the very top comment. He claims that he has irreversible impotence and has your user name in the comment. It's in almost every hair loss video. I thought you should know.

[Trinder3467]

@samlammd Hi, you might as well congratulate me I just started Proscar 5g cut into 4 pieces. My second week, so far no side effects. I couldn't seem to find Propecia on your website though. I was wondering if the prices differ.

[kamal91111]

Hi dr, I,m 26 yrs old and having hair loss problem. i have dry hair. I just had a hair transplant on the front and crown of the head. i'm also taking propecia and proscar but even i'm taking proscar when i move hand into the hair so many hairs fell down. could you please tell me what to do and which shampoo is good for dry hair. I would really appericiate if you reply.

thankyou so much

[samlammd]

hi,

thanks for the question. i honestly do not know enough about shampoos to comment. however, i do not believe that shampoos make a big difference when it comes to hair falling out.

best,

sml

[Vassia143]

Hi, I would like to know if you had an intial shed in the begging while using Proecia and how long did it last?? Thank you for your response.. :)

[PowerRedBull]

By the way, don't get me wrong for making so many comments. I think it's actually very interesting to hear 'other possible' theories about how things might work. related to these medications

[samlammd]

no problem. i welcome the input!

[PowerRedBull]

a good example is what I exprienced being on Rogaine. I was using propecia for about a year, and then I just wanted to give rogaine a try, mostly just to notice if it worked, and how much it would bother me to do it on a daily basis. Since there are never any big or real side effects mentioned, I assumed there were none, but in the period I started with rogaine, I started to get a very low libido and ED. Of course i thought propecia 'got me' after a year, because minox 'can not' have done this

[samlammd]

i have not heard of that but that is interesting. you sure there was no diet, anxiety, or other factors during that time? of course, anything is possible.

[PowerRedBull]

In your comment (that i'm just watching again) you comment although the mechanism of rogaine is not understood, it is totally safe). I think one could say is in significant studies save, but as long as the mechanism is not fully understood, I think one can not say it is 'save' . I would call it 'we assume it is save' ..or ' it is save in signigicant amount of people' ..well just my 2 cents though.

[samlammd]

fair enough. nothing in life is safe if we think of it that way even if we understand the mechanism. consider for example that minoxidil has been used since the 1980s for blood pressure and we know how that works. it is now even OTC: you do not need a prescription. at what point can we consider it safe? or do we have to be that scared to label something unsafe. i know the legal environment we live in but just putting my two cents in as well.

[PowerRedBull]

I did not mean it should be labled as "unsafe", but saying something is like 'totally safe' for example, is a description that should in my opinion not be mentioned too often with medication.

Quite alot of medication is indeed in most cases "safe", but not a guarantee.

It hard to lable it as safe or unsafe, so i always prefer terms that reflect the reality more, like for example "99% do not experience (heavy) side effects"....so it's "in most cases safe" etc. It's not black or white I think

[PowerRedBull]

So instead of the idea that the hairs that were getting shorter and thinner, get a longer period of growth and become thicker because of the propecia, the other idea is that just any hair on the head stays in the growing stage longer? or just the hairs that are getting thinner and will eventually dissapear?

It would not sound totally logically to me, but do i get this right? English is not my first language. anyone who gets it please post a reply to my message (with the reply button)

[samlammd]

that is about right.

[PowerRedBull]

Would that not mean that all hair get's thicker, which would make your overal coverage of hair more? So...people will would get 'more' hair at the sides too, that are not affected by baldness? Even fully non-balding persons? So if a man without male patte baldness, would take it, his amount of hair would increase, while with women it should not..or should? Since women hardly have DHT, it would suggest that blocking DHT would not have much chemical influence?

[PowerRedBull]

(part 2 of where i started with "So instead..."

So this lasted for about 4 months and it didn't get better and even worse (ED and low Lib), I suddenly thought back of the time I got these side effects and the time I started with Rogaine. Mostly cause I was just using it so short, I just wanted to know for sure that Rogaine was not causing my ED and Low Libido, so i stopped taking it. And the last thing I expected, though happaned, within weeks my sexdrive and erectile function came back